title: Unreplaced sex steroid deficiency, corticotropin deficiency, and lower IGF-I are associated with lower bone mineral density in adults with growth hormone deficiency: a KIMS database analysis.
abstract: BACKGROUND
  GH deficiency (GHD) is associated with low bone mineral density (BMD). Risk factors for lower BMD in this GHD population have not been fully elucidated. In particular, there are limited published data in GH-naïve subjects.
  
  
  OBJECTIVE
  The objective of the study was to identify endocrine correlates of low BMD in treatment-naïve adult GHD subjects.
  
  
  METHODS
  This was a retrospective analysis of data extracted from the (Pfizer International Metabolic Study) KIMS database.
  
  
  METHODS
  The study was an international epidemiological survey of more than 15,000 adult GHD patients from 31 countries.
  
  
  METHODS
  A total of 1218 subjects with stringently defined GHD of adult onset (641 women and 577 men) who were GH naïve and had BMD measured in the posterior anterior lumbar spine and femoral neck by dual-energy X-ray absorptiometry.
  
  
  METHODS
  Variables associated with standardized BMD (sBMD) in adult-onset GHD were examined.
  
  
  RESULTS
  In the LS, body mass index (r = 0.13, P < 0.01), unreplaced sex steroid deficiency (r = -0.17, P < 0.0001), and corticotropin deficiency (r = -0.11, P < 0.01) were independently associated with sBMD. In the FN, age (r = -0.19, P < 0.0001), female gender (r = -0.18, P < 0.0001), body mass index (r = 0.21, P < 0.0001), and decreased IGF-I SD scores (r = 0.10, P < 0.001) were independently associated with sBMD.
  
  
  CONCLUSIONS
  Hormone variables associated with lower sBMD in patients with adult-onset GHD include unreplaced sex steroid deficiency and corticotropin deficiency in the LS and lower IGF-I SDS in the FN.
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. ntritos@partners.org
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Tritos
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
authors.forename: Donna
authors.initials: D
authors.lastname: King
authors.forename: Amir
authors.initials: A
authors.lastname: Hamrahian
authors.forename: David M
authors.initials: DM
authors.lastname: Cook
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Jönsson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wajnrajch
authors.forename: Maria
authors.initials: M
authors.lastname: Koltowska-Häggstrom
authors.forename: Beverly M K
authors.initials: BM
authors.lastname: Biller
mesh_terms: D015502:Absorptiometry, Photon; D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D000328:Adult; D017668:Age of Onset; D001120:Arginine / Q000494:pharmacology; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D005951:Glucose Tolerance Test; D012739:Gonadal Steroid Hormones / Q000172:deficiency*; D013006:Growth Hormone / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000172:deficiency*; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000378:metabolism; D012189:Retrospective Studies; D012727:Sex Characteristics; D013131:Spine / Q000033:anatomy & histology; D013268:Stimulation, Chemical; D055815:Young Adult
chemical_list: D012739:Gonadal Steroid Hormones; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D001120:Arginine